Physical Therapy visit made arms weak

[deborah0904]

I had my first Physical Therapy visit today.  Basically, the Phys Therapist just evaluated me today and tested strength of my muscles.  I am very surpised at the weakness in my arms after he had me push them against his hands.  Is this normal for any of you?

[Khiba]

I am about to start PT and your information was really helpful for me too!

I know I am weak, yet the Neuros simple strength tests came back 5/5.

My arms are weak and I have been doing some light weights at home for deltoids and biceps which are helping but I don't want to do the wrong thing. So I am going for PT to get a specific program for me. :)

Thank you Ashley!

Jessica

[essdipity]

Thank you, this is very helpful.

ess

[ashleyPT]

Although the grading scale for muscle testing has specific requirements that are not supposed to fluctuate between testers - THEY DO!  I would say that getting a different number by 2 different people does not mean you have regressed.  If the same person finds a lower number at a later time then that is more likely an actual strength change.

Many people don't even like the uses of a plus or a minus because it becomes so subjective.  The general muscle grading scale is as follows:
0 - no movement
1 - trace: visible or palpable muscle contraction
2 - movement through full range in a gravity eliminated position
3 - movement through full range against gravity
4 - full range and can hold test position against moderate pressure
5 - full range and can hold test position against full pressure: normal strength

pluses and minuses are used by some scales and some people.  I am slightly biased, but the muscle testing that the majority of doctors do during an exam do not give an accurate picture of strength because they do not use standardized and accepted test positions.   They also rarely make you move against gravity especially with the lower extremity, which gives doctors the impression that you are stronger than you actually are (or they find you stronger than a good physical therapist will think you are).  Also, they sometimes don't build up and sustain the proper amount of pressure.  I've rarely been satisfied with the numbers that many doctors come up with during their strength testing as a patient and as a clinician.

[essdipity]

I'm really glad you're here. My question is this: If a neuro does strength tests and finds, for example, that your hip or hips rate a 4+ on the scale, and later on a PT gives you a 4-, can you be sure that you have regressed, or could this be just a difference between the two administering the tests?

Thank you,
ess

[ashleyPT]

..."If they do that stuff".....That is a therapist job and I am shocked that there is a PT out there who didn't evaluate your weakness.  I would not follow up with any PT that didn't do an evaluation of strength, ROM, balance, and your baseline functional level on the first day.  Otherwise there is no way of seeing improvement.  There is a lot of variety in PT practice. The field has been moving more towards objective measures, specific exercises, and functional improvements and away from modalities such as heat, massage, ultrasound etc, but many PTs aren't making the change.  So shop around to find one.  

I would say that many of my patients are tired after the evaluation - especially patients that  have fatigue as a component of their diagnosis.

[Wobbly]

Hi there... is this Physical Therapy apart of a MS centre?  Or who referred you or how did you find the therapist... ?  I'm asking cause when I went to a Physio Therapist at the referral of the MS clinic... the therapist didn't do anything like that?  

is the PT part of getting the Dx.. or because of you Dx.. they refer you there?  I just don't know if I should still be going to a PT.. mine just massaged my neck and put a TENS thing on my shoulder to help with shoulder pain...didn't help with my left sided weakness at all and wouldn't even acknowlegde it when I asked about getting help with it.. ummmmm  lets just say I'm not seeing him anymore..

so ... I would like a therapist that would evaluate me on my weakness, pain level etc... if they do that stuff...?

take  care
wobbly
undx